The invention relates to a device for ligating an anatomical structure.
The device of the invention relates to the field of surgical equipment making it possible to perform surgery, in particular in small spaces, especially under celioscopy. That minimally-invasive technique involving the use of fine, cylindrical instruments passed through the abdominal wall without using a large opening makes it impossible to use the fingers or the hand.
For example, for surgical resection of the vermiform (or cecal) appendix, the operation is relatively simple when it is performed via conventional open surgery; it is necessary to control and then cut the vessels that supply the appendix and that are included in an anatomical fold known as the “mesoappendix”. Then the junction between the base of the appendix and the cecum, which is the lower portion of the right colon must be ligated. Finally, the appendix must be cut off just above the ligature. The celioscopic technique also involves these operating stages, but it represents a more difficult technique. The difficulty raised by the section of the mesoappendix is currently solved, for this type of surgery, either by using an electric knife, or by using metal clips. But the use of electrical power is dangerous, and should be avoided. As for using metal clips, that requires equipment that is complex, costly, and sometimes of inappropriate size. Ligating the appendicular base, which, in theory, is relatively easy, is often more difficult than expected. Pre-mounted slip knots are available but they are flexible, so passing them around the appendix requires great care, and they must be tightened with precaution so as not to cut off the appendix completely, but sufficiently tightly so that the knot does not come undone and so that the tissue does not slip.
The state of the art is illustrated by WO 01/34038, U.S. Pat. Nos. 5,476,206 and 5,433,721.
WO 01/34038 describes an instrument making it possible to take hold of an appendicular stump and to slide an elastic band over it. The same technique is used for the mesoappendix. That assumes that the appendix is thin enough and flexible enough to be received in the instrument, and that the mesoappendix is thin enough and flexible enough, or that the base of the appendix and the mesoappendix have already been cut off.
In certain special cases when the appendix is extremely reworked or has increased in volume, it can be necessary to use more complex and costly instruments such as those described in Patents U.S. Pat. Nos. 5,476,206 and 5,433,721. Those instruments make it possible to staple two rows of staples and to cut between the two rows. Admittedly, the result is satisfactory but such instruments cannot be used systematically because they require accesses that are larger than those usually formed for surgical resection of the appendix, and they are costly. The accesses required for such instruments have diameters lying in the range 10 millimeters (mm) to 12 mm instead of 5 mm;
Currently, no other equipment exists for performing the various surgical stages.